Hepatitis A and E Infection in International Travellers

Article

Abstract

Hepatitis A is the most common vaccine-preventable infection in travellers. The incidence of hepatitis A for travellers ranges from 3.0 to 11.0 per 100,000 person-months and the case-fatality rate is as high as 2 per 100,000 in non-immune travellers. Hepatitis A vaccine is highly effective in preventing infection, significantly reducing the incidence of hepatitis A in travellers, and an important preventative intervention for the “last-minute” traveller. Hepatitis E virus is an important cause of enterically transmitted hepatitis in developing countries. The overall risk of hepatitis E in travellers visiting endemic countries is relatively low compared to hepatitis A. The majority of cases have been reported from the Indian subcontinent. The case fatality rate for hepatitis E is 1.2%, although this is substantially higher in pregnant women. A vaccine for hepatitis E is not available, and therefore travellers must be made aware of preventative measures to reduce their risk of infection.

Keywords

Hepatitis A Hepatitis E Travellers Liver failure Vaccines 

References

Papers of particular interest, published recently, have been highlighted As: • Of importance •• Of major importance

  1. 1.
    Loscher T, Keystone JS, Steffen R. Vaccination of travelers against hepatitis A and B. J Travel Med. 1999;6:107–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Lemon SM, Jansen RW, Brown EA. Genetic, antigenic and biological differences between strains of hepatitis A virus. Vaccine. 1992;10 Suppl 1:S40–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Mutsch M, Spicher VM, Gut C, et al. Hepatitis A virus infections in travelers, 1988–2004. Clin Infect Dis. 2006;42:490–7.PubMedCrossRefGoogle Scholar
  4. 4.
    •• Askling HH, Rombo L, Andersson Y, et al. Hepatitis A risk in travelers. J Travel Med. 2009;16:233–8. This article provides an excellent review of hepatitis A in travellers. Google Scholar
  5. 5.
    Steffen R, Kane MA, Shapiro CN, et al. Epidemiology and prevention of hepatitis A in travelers. JAMA. 1994;272:885–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Daniels D, Grytdal S, Wasley A. Surveillance for acute viral hepatitis—United States, 2007. Centers for Disease Control and Prevention (CDC). MMWR Surveill Summ. 2009 May 22;58(3):1–27. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5803a1.htm.
  7. 7.
    Guerrant RL, Walker DH, Weller PF. Tropical infectious diseases: principles, pathogens, & practice. 2nd ed. Philadelphia: Elsevier Churchill Livingstone; 2006.Google Scholar
  8. 8.
    The Australian Immunisation Handbook 9th Edition 2008. Available at http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-hepatitisa.
  9. 9.
    Connor BA. Hepatitis A vaccine in the last-minute traveler. Am J Med. 2005;118(Suppl 10A):58S–62S.PubMedCrossRefGoogle Scholar
  10. 10.
    Wiersma S. CDC Yellow Book Chapter 2 Hepatitis A. CDC; 2010 [cited 2010 31-8-2010]. Available at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/hepatitis-a.aspx.
  11. 11.
    Clemens R, Safary A, Hepburn A, et al. Clinical experience with an inactivated hepatitis A vaccine. J Infect Dis. 1995;171 Suppl 1:S44–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Hepatitis A. Vaccine. Med Lett Drugs Ther. 1995;37:51–2.Google Scholar
  13. 13.
    Van Herck K, Van Damme P, Lievens M, et al. Hepatitis A vaccine: indirect evidence of immune memory 12 years after the primary course. J Med Virol. 2004;72:194–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Laurence JC. Hepatitis A and B immunizations of individuals infected with human immunodeficiency virus. Am J Med. 2005;118(Suppl 10A):75S–83S.PubMedCrossRefGoogle Scholar
  15. 15.
  16. 16.
    Craig AS, Schaffner W. Prevention of hepatitis A with the hepatitis A vaccine. N Engl J Med. 2004;350:476–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htm.
  18. 18.
    D’Argenio P, Adamo B, Cirrincione R, et al. The role of vaccine in controlling hepatitis A epidemics. Vaccine. 2003;21:2246–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Taliani G, Gaeta GB. Hepatitis A: post-exposure prophylaxis. Vaccine. 2003;21:2234–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Werzberger A, Mensch B, Kuter B, et al. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med. 1992;327:453–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaic B, Borcic B, Ljubicic M, et al. Hepatitis A control in a refugee camp by active immunization. Vaccine. 2001;19:3615–9.PubMedCrossRefGoogle Scholar
  22. 22.
    •• Victor JC, Monto AS, Surdina TY, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007;357:1685–94. This is a very important publication demonstrating the effectivenss of hepatitis A vaccine compared to immunoglobulin in disease outbreaks. Google Scholar
  23. 23.
    McMahon BJ, Beller M, Williams J, et al. A program to control an outbreak of hepatitis A in Alaska by using an inactivated hepatitis A vaccine. Arch Pediatr Adolesc Med. 1996;150:733–9.PubMedGoogle Scholar
  24. 24.
    •• Dalton HR, Bendall R, Ijaz S, et al. Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis. 2008;8:698–709. This article provides an excellent review of hepatitis E. Google Scholar
  25. 25.
    •• Aggarwal R, Naik S. Epidemiology of hepatitis E: current status. J Gastroenterol Hepatol. 2009;24:1484–93. This excellent review describes the global distribution of the major genotypes of hepatitis E virus. Google Scholar
  26. 26.
    Mushahwar IK. Hepatitis E virus: molecular virology, clinical features, diagnosis, transmission, epidemiology, and prevention. J Med Virol. 2008;80:646–58.PubMedCrossRefGoogle Scholar
  27. 27.
    Piper-Jenks N, Horowitz HW, Schwartz E. Risk of hepatitis E infection to travelers. J Travel Med. 2000;7:194–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Cowie BC, Breschkin A, Kelly H. Hepatitis E virus: overseas epidemics and Victorian travellers. Med J Aust. 2005;183:491.PubMedGoogle Scholar
  29. 29.
    Labrique A, Nelson K. Hepatitis E virus infections among US military personnel deployed to Afghanistan. J Infect Dis. 2010;202:1297–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Labrique AB, Zaman K, Hossain Z, et al. Population seroprevalence of hepatitis E virus antibodies in rural Bangladesh. Am J Trop Med Hyg. 2009;81:875–81.PubMedCrossRefGoogle Scholar
  31. 31.
    Labrique AB, Zaman K, Hossain Z, et al. Epidemiology and risk factors of incident hepatitis E virus infections in rural Bangladesh. Am J Epidemiol. 2010;172:952–61.PubMedCrossRefGoogle Scholar
  32. 32.
    Arankalle VA, Tsarev SA, Chadha MS, et al. Age-specific prevalence of antibodies to hepatitis A and E viruses in Pune, India, 1982 and 1992. J Infect Dis. 1995;171:447–50.PubMedCrossRefGoogle Scholar
  33. 33.
    Potasman I, Koren L, Peterman M, et al. Lack of hepatitis E infection among backpackers to tropical countries. J Travel Med. 2000;7:208–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Smalligan RD, Lange WR, Frame JD, et al. The risk of viral hepatitis A, B, C, and E among North American missionaries. Am J Trop Med Hyg. 1995;53:233–6.PubMedGoogle Scholar
  35. 35.
    Clayson ET, Innis BL, Myint KS, et al. Short report: relative risk of hepatitis A and E among foreigners in Nepal. Am J Trop Med Hyg. 1995;52:506–7.PubMedGoogle Scholar
  36. 36.
    Mushahwar IK, Dawson GJ, Bile KM, et al. Serological studies of an enterically transmitted non-A, non-B hepatitis in Somalia. J Med Virol. 1993;40:218–21.PubMedCrossRefGoogle Scholar
  37. 37.
    Bile K, Isse A, Mohamud O, et al. Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia. Am J Trop Med Hyg. 1994;51:466–74.PubMedGoogle Scholar
  38. 38.
    Colson P, Borentain P, Queyriaux B, et al. Pig liver sausage as a source of hepatitis E virus transmission to humans. J Infect Dis. 2010;202:825–34.PubMedCrossRefGoogle Scholar
  39. 39.
    Kumar A, Aggarwal R, Naik SR, et al. Hepatitis E virus is responsible for decompensation of chronic liver disease in an endemic region. Indian J Gastroenterol. 2004;23:59–62.PubMedGoogle Scholar
  40. 40.
    Singh S, Mohanty A, Joshi YK, et al. Mother-to-child transmission of hepatitis E virus infection. Indian J Pediatr. 2003;70:37–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Sookoian S. Liver disease during pregnancy: acute viral hepatitis. Ann Hepatol. 2006;5:231–6.PubMedGoogle Scholar
  42. 42.
    Legrand-Abravanel F, Kamar N, Sandres-Saune K, et al. Characteristics of autochthonous hepatitis E virus infection in solid-organ transplant recipients in France. J Infect Dis. 2010;202:835–44.PubMedCrossRefGoogle Scholar
  43. 43.
    Dalton HR, Bendall RP, Keane FE, et al. Persistent carriage of hepatitis E virus in patients with HIV infection. N Engl J Med. 2009;361:1025–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Gerolami R, Moal V, Colson P. Chronic hepatitis E with cirrhosis in a kidney-transplant recipient. N Engl J Med. 2008;358:859–60.PubMedCrossRefGoogle Scholar
  45. 45.
    Kamar N, Selves J, Mansuy JM, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med. 2008;358:811–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Haagsma EB, van den Berg AP, Porte RJ, et al. Chronic hepatitis E virus infection in liver transplant recipients. Liver Transplant. 2008;14:547–53.CrossRefGoogle Scholar
  47. 47.
    Hosseini-Moghaddam SM, Zarei A, Alavian SM, et al. Hepatitis E virus infection: a general review with a focus on hemodialysis and kidney transplant patients. Am J Nephrol. 2010;31:398–407.PubMedCrossRefGoogle Scholar
  48. 48.
    Kumar A, Beniwal M, Kar P, et al. Hepatitis E in pregnancy. Int J Gynaecol Obstet. 2004;85:240–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Drobeniuc J, Meng J, Reuter G, et al. Serologic assays specific to immunoglobulin M antibodies against hepatitis E virus: pangenotypic evaluation of performances. Clin Infect Dis. 2010;51:e24–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Chadha MS, Walimbe AM, Arankalle VA. Retrospective serological analysis of hepatitis E patients: a long-term follow-up study. J Viral Hepat. 1999;6:457–61.PubMedCrossRefGoogle Scholar
  51. 51.
    • Shrestha MP, Scott RM, Joshi DM, et al. Safety and efficacy of a recombinant hepatitis E vaccine. N Engl J Med. 2007;356:895–903. This article is a key publication on a hepatitis E vaccine candidate. Google Scholar
  52. 52.
    •• Zhu FC, Zhang J, Zhang XF, et al. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet. 2010;376:895–902. This article describes a well-conducted and very large trial reporting on a highly efficacious hepatitis E vaccine candidate. Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Infectious Diseases, Austin Center for Infection ResearchAustin HospitalHeidelbergAustralia
  2. 2.Department of Medicine, Austin HospitalUniversity of MelbourneHeidelbergAustralia

Personalised recommendations